Outcomes of cavotricuspid isthmus-dependent flutter ablation: randomized study comparing single vs. multiple catheter procedures—the SIMPLE study
verfasst von:
Diego Penela, Alfredo Chauca, Juan Fernández-Armenta, Ricardo Pavón, Begoña Benito, Juan Acosta, Jose Miguel Lozano, Giulio Falasconi, Rodolfo San Antonio, David Soto-Iglesias, Julio Martí-Almor, Augusto Ordoñez, Aldo Bellido, José Miguel Carreño, Maria Matiello, Lucas Cano, Alonso Pedrote, Daniel Viveros, Jose Alderete, Pietro Francia, Maria Algarra-Cullell, Etelvino Silva, Julia Meca-Santamaria, Paula Franco, Riccardo Cappato, Antonio Berruezo
Catheter ablation is recommended as first-line therapy for patients with symptomatic typical AFl. Although the conventional multi-catheter approach is the standard of care for cavotricuspid isthmus (CTI) ablation, a single-catheter approach was recently described as a feasible alternative. The present study sought to compare safety, efficacy, and efficiency of single vs. multi-catheter approach for atrial flutter (AFl) ablation.
Methods
In this randomized multi-center study, consecutive patients referred for AFl ablation (n = 253) were enrolled and randomized to multiple vs. single-catheter approach for CTI ablation. In the single-catheter arm, PR interval (PRI) on the surface ECG was used to prove CTI block. Procedural and follow-up data were collected and compared between the two arms.
Results
128 and 125 patients were assigned to the single-catheter and to the multi-catheter arms, respectively. In the single-catheter arm, procedure time was significantly shorter (37 ± 25 vs. 48 ± 27 minutes, p = 0.002) and required less fluoroscopy time (430 ± 461 vs. 712 ± 628 seconds, p < 0.001) and less radiofrequency time (428 ± 316 vs. 643 ± 519 seconds, p < 0.001), achieving a higher first-pass CTI block rate (55 (45%) vs. 37 (31%), p = 0.044), compared with the multi-catheter arm. After a median follow-up of 12 months, 11 (4%) patients experienced AFl recurrences (5 (4%) in the single-catheter arm and 6 (5%) in the multi-catheter arm, p = 0.99). No differences were found in arrhythmia-free survival between arms (log-rank = 0.71).
Conclusions
The single-catheter approach for typical AFl ablation is not inferior to the conventional multiple-catheter approach, reducing procedure, fluoroscopy, and radiofrequency time.
Graphical Abstract
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Outcomes of cavotricuspid isthmus-dependent flutter ablation: randomized study comparing single vs. multiple catheter procedures—the SIMPLE study
verfasst von
Diego Penela Alfredo Chauca Juan Fernández-Armenta Ricardo Pavón Begoña Benito Juan Acosta Jose Miguel Lozano Giulio Falasconi Rodolfo San Antonio David Soto-Iglesias Julio Martí-Almor Augusto Ordoñez Aldo Bellido José Miguel Carreño Maria Matiello Lucas Cano Alonso Pedrote Daniel Viveros Jose Alderete Pietro Francia Maria Algarra-Cullell Etelvino Silva Julia Meca-Santamaria Paula Franco Riccardo Cappato Antonio Berruezo
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